Anger attacks in bipolar depression: predictors and response to citalopram added to mood stabilizers.
Anger attacks in bipolar depression: predictors and response to citalopram added to mood stabilizers.
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DOI：
10.4088/jcp.v65n0506
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发表时间：
2004-05
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影响因子：
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通讯作者：
O. Mammen;P. Pilkonis;K. Chengappa;D. Kupfer
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文献类型：
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作者：
O. Mammen;P. Pilkonis;K. Chengappa;D. Kupfer
背景在文献中关于双相抑郁症愤怒发作的2篇报道中，1篇发现与双相混合状态和单相抑郁症的发生率（40%-60%）相比，愤怒发作不常见（12%），而另1篇发现愤怒发作常见（62%）。我们在一项为期8周的开放标签西酞普兰加情绪稳定剂治疗双相抑郁症的试验中检查了参与者的愤怒发作。我们还研究了特质愤怒、轻躁狂症状和抑郁症状作为愤怒发作的预测因子。我们假设，如果愤怒发作与轻躁狂症状有关，他们对西酞普兰的反应会不利，而如果他们与特质愤怒或抑郁症状有关，他们会对西酞普兰的反应有利。方法对45例DSM-IV诊断为双相I型或II型抑郁症的受试者分别采用改良的愤怒发作问卷、Young躁狂量表和汉密尔顿抑郁量表进行愤怒发作、轻躁狂症状和抑郁症状评估。特质愤怒使用状态特质愤怒量表进行测量。在西酞普兰治疗8周结束时或从试验中脱落时收集治疗后数据。第一次参与者研究访问是在1998年11月，最后一次参与者研究访问是在2000年12月。结果：在西酞普兰治疗前，44名参与者中有17名（38.6%）报告了愤怒发作（1名参与者治疗前和4名参与者治疗后的愤怒发作数据缺失）。治疗后报告愤怒发作的参与者明显减少（41人中有6人，14.6%; McNemar检验，p <0.05，双尾）。在治疗前和治疗后，特质愤怒是愤怒发作的唯一显著预测因子（p <0.05）。结论：这些研究结果表明，在双相抑郁症中，愤怒发作是常见的，可能对西酞普兰加情绪稳定剂的急性治疗反应良好，并且特质愤怒比轻躁狂或抑郁症状更好地预测。需要进一步的研究来阐明双相抑郁症中愤怒发作的诊断和治疗意义。
BACKGROUND Of the 2 reports in the literature on anger attacks in bipolar depression, one found them to be uncommon (12%) compared with the rate in bipolar mixed states and unipolar depression (40%-60%), whereas the other found them to be common (62%). We examined anger attacks among participants in an 8-week trial of open-label citalopram added to mood stabilizer for the treatment of bipolar depression. We also examined trait anger, hypomanic symptoms, and depressive symptoms as predictors of anger attacks. We hypothesized that if anger attacks were related to hypomanic symptoms they would respond unfavorably to citalopram, whereas if they were related to trait anger or depressive symptoms they would respond favorably. METHOD In 45 participants with a DSM-IV diagnosis of bipolar I or II depression, anger attacks, hypomanic symptoms, and depressive symptoms were assessed using a modified Anger Attacks Questionnaire, Young Mania Rating Scale, and Hamilton Rating Scale for Depression, respectively. Trait anger was measured using the State-Trait Anger Inventory. Posttreatment data were collected at the end of 8 weeks of treatment with citalopram or at dropout from the trial. The first participant study visit was in November 1998, and the final participant study visit was in December 2000. RESULTS Before treatment with citalopram, 17 (38.6%) of 44 participants reported anger attacks (data on anger attacks were missing for 1 participant before treatment and 4 after treatment). Significantly fewer participants reported anger attacks after treatment (6 of 41, 14.6%; McNemar test, p <.05, 2-tailed). At pretreatment and post-treatment, trait anger was the only significant predictor of anger attacks (p <.05). CONCLUSIONS These findings suggest that in bipolar depression anger attacks are common, may respond favorably to acute treatment with citalopram added to mood stabilizer, and are better predicted by trait anger than hypomanic or depressive symptoms. Further studies are needed to clarify the diagnostic and treatment implications of anger attacks in bipolar depression.